Provider Demographics
NPI:1235562190
Name:STOECKLE ENTERPRISES, INC.
Entity Type:Organization
Organization Name:STOECKLE ENTERPRISES, INC.
Other - Org Name:SWEET WATER AT LARGO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KORY
Authorized Official - Middle Name:KAE
Authorized Official - Last Name:STOECKLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-389-1045
Mailing Address - Street 1:2521 REGAL RIVER RD
Mailing Address - Street 2:
Mailing Address - City:VALRICO
Mailing Address - State:FL
Mailing Address - Zip Code:33596-8307
Mailing Address - Country:US
Mailing Address - Phone:813-389-1045
Mailing Address - Fax:813-662-0026
Practice Address - Street 1:11290 WALSINGHAM RD
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33778-3101
Practice Address - Country:US
Practice Address - Phone:727-398-1407
Practice Address - Fax:727-398-1407
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-14
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL-8175310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility